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By: Monica Thuch, BSN, RN
Published: 1/23/2024
Ouch! This is one word you hope to never hear during a case! While everyone hopes that a sharps injury never occurs, it still may. As a new nurse, it can be quite embarrassing and even intimidating to vocalize that you have received an injury, but remembering that your safety is just as important as your patient’s is key! In this article, I will share ways to prevent sharps injuries and provide some tips and tricks on what to do during and after a sharps injury.
In the beginning of my nursing career, I recall an experienced nurse explaining that I have to take care of myself before I can even begin to care for others. She also stated that ensuring my safety is just as important as ensuring a patient’s safety because we both have families to go home to. I can still hear that nurse’s voice: “Keep yourself safe, so that you can keep everyone else safe.” She went into more details, such as, if I hurt myself by rushing at the field and, let’s say, accidentally cut myself with a blade, this would mean that not only would I be putting myself at risk, but also the patient. Being in a situation where I am actively bleeding or stuck with a needle meant I’d have to step away from the case. This in turn would result in delaying the patient’s surgery and recovery period, and possibly even contaminating certain supplies and instruments. This conversation has never left me and truly put into perspective just how important it is to be aware of what’s going on at all times. Ensuring your own safety keeps patients out of harm’s way and that is always the mission.
Figure 1. Stats on sharps injuries. Information from https://internationalsafetycenter.org/exposure-reports/
Let’s dive into some things that can help prevent sharps injuries. From my own experience, I have learned just how important teamwork and communication are in surgery. I feel more comfortable vocalizing things out loud, such as “Sharps down on Mayo” or “15 blade up for incision.” This lets everyone in the room know exactly what is going on and provides an image in everyone’s head of a sharp’s location.
A small rectangular basin or a magnetic pad at the field can act as the safe zone (sometimes called a neutral zone) when passing sharp instruments or devices, blades, and needles. A designated safe zone or neutral zone can help avoid hand-to-hand transfers, which can significantly decrease injuries because sharps can be placed down in this one area so that only one person's hand can grab the sharp at a time.1 Too many hands in the “safe zone” pot can most certainly lead to injury. Having a clear understanding of a safe zone and the expectation that only one hand can be in this area can significantly reduce accidents and injuries.
I have had surgeons place a hypo needle in the safe zone basin while stating, “Hypo needle in basin down.” Once this is verbalized, I can grab this item to take to my back table, which keeps everyone in the loop while also keeping everyone safe. Occasionally, I go a step further by stating back that the sharp has been placed back on my table; this helps to keep everyone on the same page regarding what’s happening with that exact item. During surgery, there can be many things occurring at once, but ensuring that there is a designated safe zone and keeping open communication at all times can help prevent accidents.
It is important to also understand that sharps safety doesn’t end intraoperatively. There have been times when I have had to break a set down completely because a blade was left on a knife handle, which delayed the case; however, it also could’ve hurt me had I not scanned the set before touching the instruments. After a case, the scrub person should remove sharp items, such as blades, Jackson-Pratt drain spikes, and needles, from their workspace and place them in the red sharps bin. Together, the scrub person and RN circulator should confirm that all sharps have been removed, accounted for, and discarded properly. Both parties should sign off on either a count sheet or in the physical chart before sending these used instruments for processing; this holds them accountable for keeping surgical and instrument processing colleagues safe the next time this instrument set may be used or during the cleaning process.
Asking clear and direct questions allows you to be fully ready and prepared for anything that may occur during surgery, which in turn, helps prevent sharps-related injuries by avoiding high pressure situations that require you to act quickly. For example, asking questions regarding what items are needed before a case will allow you to be ready with the correct supplies, like having a 15 blade instead of an 11 blade. Asking questions during the case can help you anticipate what can occur next. If there’s a ton of bleeding and the case is moving at a rapid pace, you can protect everyone by asking, for example, “What suture do you think you may use for the bleeding?”, “What will you be using for closing?”, or “What needle will you use to inject local?” This lets you know, for example, the exact suture being used and allows you to have the correct sutures loaded onto the needle driver ready to go.
While prevention is key, accidents do occur. And, when an injury does occur, you will need to be ready with your hospital’s protocol of the exact steps to follow. Knowing just what to do during and after an injury helps to keep patients and other staff members safe.
The very first thing the scrub person should do if injured is to communicate to the team that there has been a sharps injury and the case must be stopped, if possible. For example, they can say, “Team, we need to pause because I cut myself with the 15 blade.” While it may be intimidating to vocalize that you have been injured, you must prioritize safety. You do not want to worry about the possibility of catching anything bloodborne or breaking the sterile field and putting the patient at risk of infection.
Next, the scrub person should remove any contaminated sharps, supplies, and instruments from the field. They can put the contaminated item into a basin or an aluminum medication cup, which is usually already on the field, and hand it off to the gloved RN circulator. This keeps the table sterile.
The scrub person should take a step away from their field while the RN circulator calls a manager to identify if someone is available to fill in for the scrub role. The circulator or scrub person can inform the manager about what has occurred. The injured area should then be washed, required documentation filled out, and the occupational medicine office visited to figure out next steps.
The surgical team should provide support to the injured colleague during what can be a very scary moment! For example, the RN circulator can call for additional help to get the scrub person out of the case and can even prepare the injury paperwork for them to move on to the next step of being evaluated by occupational medicine.
In the OR, communicating is key! You should feel empowered, use your voice, and always establish a safe zone with your team. If an injury does occur, you should speak up. You should strive to be the best you can be for yourself and your patients.
Reference
In this week’s Periop Life blog, learn how perioperative nurses can prevent these injuries with evidence-based care bundles. Dr. Ray-an Talatala shares five essential strategies, including proactive skin assessments, to strengthen patient safety and teamwork.
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